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. Last Updated: 07/27/2016

Keeping Ills and Chills at Bay for Moscow Babies

The baby was delivered without complications. The mother is rested and doing well. It will soon be time to leave the sanitized seclusion of a Western hospital and return to the safety of ...


Moscow.


Even in the best of circumstances, bringing up a baby in a country with a health system as decrepit as Russia's can be a cause for concern.


Physicians living and working in Moscow offer the following suggestions about how to prevent run-ins with the medical system here, and how to cope with emergencies if they arise.


For starters, physicians say it is important to ensure babies are vaccinated against life-threatening diseases. Some confusion may arise, however, because there are significant differences between vaccination schedules in Europe, the United States and Russia.


Like most Western countries, Russia requires the standard battery of vaccinations against measles, mumps, rubella, polio, diphtheria, tetanus and pertussis. However, most Russian babies are also inoculated at birth against Hepatitis B as well as tuberculosis -- vaccines neither recommended nor required in most Western countries.


Dr. Eric Downing, chief medical officer of the International Medical Clinic, one of four Western-style centers in Moscow, recommends parents inoculate babies against Hepatitis B if they are going to be raised in Russia.


Downing also advises a vaccine for Hepatitis A, which is usually spread through contaminated food or water, for anyone living in Russia for more than six months. Children must be 7 years old, though, before receiving this particular inoculation, said Downing.


Hepatitis is a viral inflammation of the liver that causes nausea, fever, weakness, loss of appetite and, usually, jaundice. Hepatitis B is normally transmitted by transfusions of infected blood or use of poorly sterilized medical instruments.


The tuberculosis vaccine is more controversial. It is meant to guard against infection from TB, which spreads primarily from inhalation of minute droplets of bacteria that become airborne when infected people sneeze or cough.


The levels of TB infection in Russia are among the highest in Europe, according to the World Health Organization. In 1995, there were 57.4 cases per 100,000 people, according to Valentina Aksyonova, deputy director of Russia's central research center for tuberculosis.


In light of the growing numbers of people afflicted with TB, Russian physicians are stalwart in administering the TB vaccine, also known as BCG. But Downing from the IMC and Dr. Timothy Meade, the medical director of another Western-style clinic, the American Medical Center, advise parents against the vaccine.


"TB is a threat," said Downing, "but the BCG vaccines they give at birth are controversial. ... They have not been proven to be effective."


Although most popular vaccines are about 98 percent effective, the BCG vaccine falters at about 70 percent -- which means that three out of 10 people will contract TB in spite of the inoculation, said Meade.


"The reason we don't [administer the vaccine] in America is because they've looked at the relative risks of contracting [TB] and weighed that against the effectiveness of the vaccine, which is not great. It can also cause confusion later in life ... in determining whether or not you've been exposed to tuberculosis," Meade said.


Results from skin tests of people vaccinated against TB earlier in life appear to show exposure to the disease. In such instances, a chest x-ray can be the only definitive test to determine exposure.


Differences of opinion between Russian and Western doctors aren't limited to the TB vaccine. Like most Russian physicians, Dr. Lidiya Ivanova, the chief of the children's department at the UPDKh poliklinika, or clinic, recommends keeping babies away from public spaces like the metro for at least the first year.


Meade, however, said an infant should be transported in a carrying device for protection against the jostling in the metro. "But there's nothing inherent about the metro ... that would be dangerous to infants," he said.


Downing is less emphatic. "I wouldn't be concerned about going outside at all, but ... I might be a little hesitant in the metro with the flu season, and everyone coughing," he said.


None of the physicians were especially fearful that a child stands a greater likelihood of contracting TB in such circumstances.


"Fortunately it's a little bit hard to transmit [TB] that way. That kind of thing doesn't generally happen on the metro," said Meade, adding that TB bacteria are larger than more common strains, such as influenza, and do not take hold as easily.


As for going outside in the winter -- another touchy subject -- Dr. Thierry Metzger of the European Medical Center, says, "Of course [a baby] can go out. There's no problem at all." As long as the baby is properly protected from cold, heat and sunlight, he added.


In instances when a baby does get sick, parents can consult a Russian-trained pediatrician up to three times a week at both the AMC and the EMC and once a week at the IMC. Such a specialist is unavailable at Mediclub, said Dr. Jacques Roy. Parents with sufficient language skills can also consult a Russian doctor at their neighborhood children's poliklinika.


In emergency situations, a trip to the hospital is necessary. All four Western-style outpatient clinics -- AMC, EMC, IMC and Mediclub -- serve as conduits to Russian health care institutions. They recommend that parents contact them, first, in an emergency, so that a clinic representative can ease the bureaucratic snags that could mean the difference between a child's life and death.


Choosing a hospital for major emergencies beforehand is especially important because Russian law dictates that children be treated in separate facilities from adults, according to Meade. This means that even if you arrive at a reputable hospitable for adults, you and your child could be turned away.


"Don't pick a hospital at random," said Downing. "If you dial 03, you're just taking your chances."